Management-initiated fraud?

kp2016 · Nov 25, 2019

I do agree with you that it's hard to believe that anyone could accurately recall this information several weeks later but I have worked with nurses who in a similar situation insisted they had perfect recall.

I personally felt they were just choose information consistent with the patient's chart and documenting them. Obviously I did not say so as that would be accusing someone of lying and falsifying a chart. In the EMR that we had it was marked as a late entry with the actual date and time of entry clearly marked. So yes, it's certainly a red flag in my eyes, but when a nurse will document it and sign her name to it and look you in the eye and swear that she remembers this information to be a fact.......

It seems to me it would be better for management to focus on ensuring that in future the blood sugars are actually checked and insulin is actually administered and documented. Sadly as with most accreditation visits management is mainly interested in checking all the boxes and passing. What actually happens every day before or after the visit isn't really the focus.

It also occurs to me this is about billing and payment. I'm sure they need to show this care occured to justify the fact that it was billed. Is that ethical? Not at all. Would I personally pick this fight? Never in a million years. I'm personally very grateful i've never been in the position of being asked to "remember".

CharleeFoxtrot, BSN, RN · Nov 25, 2019

26 minutes ago, kp2016 said:
.... Sadly as with most accreditation visits management is mainly interested in checking all the boxes and passing. What actually happens every day before or after the visit isn't really the focus.

As appalling it may be, this is the truth. In my brief time working in that environment I saw management direct employees to do very similar things before an expected audit. One of the many contributing factors to my leaving that aspect of our profession.

Guest219794 · Nov 25, 2019

What is the proper course of action for nurses in this position?

That depends on the nurse- how bad do they need their job? There is something called "The straight face test". Can you tell me with a straight face that a LTC remembers a sugar from 2 weeks ago, unless it is 6 or 600?

Personally, I would email the boss, explaining that it was my mistake, and ask what he/she would like done, as I don't remember the BS. Email at least give you something in writing. If I am going to lie for somebody else's benefit, at least we can share the blame if we get caught.

The managers have eluded to the notion that they want these missed chartings fixed by the time state is here, so it feels like they are asking nurses to put their licenses at risk in order to make the facility look better.

Of all the things a people here are falsely scared of losing a license for, this one could be legit. Probably not lose it, but certainly some kind of discipline for deliberately and knowingly lying.

Would nurses be in as much trouble for administering insulin properly but forgetting to chart it?

Probably not. Making a mistake is one thing, falsifying a medical record is another.

Well described here. https://www.americannursetoday.com/documentation-youve-got-lot-lose/

“the intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.”

No question, at all, whether or not this would be fraud- other than the argument that a nurse who does hundreds of blood sugars remembers one. If I wanted to shut that person down, I would just pull another chart from the same day, and ask the nurse to recall a few other blood sugars.

I was always told that if it wasn't charted, it didn't happen

One of those things often repeated, not really examined. If I don't chart putting a foley in, and the PT goes from the ER to the floor, nobody is going to claim there is no foley. Clearly it happened. Or, try slapping a PT in the face and not charting it, then using that as a defense.

The truth is that not charting something shows a lack of diligence and professionalism.

It altogether feels like an ethical dilemma.

No it doesn't. An ethical dilemma is misleading a PT with dementia so she takes medicine you believe will help her. An ethical dilemma is coding somebody you know would not want it, but the doc screwed up and did not put in a DNR.

Committing fraud to avoid an inconvenient confrontation with management is a dilemma, but but the ethics are clear.

It is a crappy position to be in. Nurses are often faced with dilemma of good patient care, or documentation that makes admin happy. I just worked a critical case with a relatively new nurse, who took notes, then had to piece together 3 hours of full on critical care. Had she stood at the computer and documented in real time, the patient might have died, but she wouldn't be getting annoying memos for the next two weeks. "Is there a stop time for the poresors you stopped on an intubated pt who had a disturbing spike in pressure while in CT....."

JKL33 · Nov 25, 2019

I agree this is not an ethical dilemma.

I would only agree to add a late entry if I recalled with certainty every element that I was charting. This is one of those "just say no" things. If you are absolutely 100% certain that you administered the insulin and you know how much you administered and an approximate time for having done so, you could offer to chart that if they will allow you to do so in a manner that doesn't require you to falsify anything else, such as the hard stop of needing the BS results.

Beyond that, no. Probably not a bad idea to email first, asking what to do if you don't recall the blood sugar and wait for their response as suggested by @hherrn. But eventually it will come down to saying, "I'm sorry but I can't do that; I don't recall the required information" if they suggest that you must chart it a certain way beyond what you can recall.

Guest219794 · Nov 25, 2019

The email thing is kind of a passive aggressive thing I sometimes do. It requires the other person to acknowledge something I think they might at some point be reluctant about.

I am sometimes subtle to avoid a conflict, but I save the email.

kp2016 · Nov 25, 2019

I read this as the OP was concerned about the request (demand) from management / late charting by other RN's. I took their "ethical dilemma" to be should they report this very late charting as potential falsifying the medical record/ insurance fraud.

I'm now curious if the asking for a friend style question is actually about their own practise or if they are actually torn on if they should be looking to report this to a regulatory body.

ocean.baby · Nov 26, 2019

I worked with a new nurse for four hours - first time I had worked with her, who had not charted that the blood sugars were done before dinner. I asked her if she had done them, and if not I would be happy to help her get them. She said that she got them. She then charted five blood sugars without having any kind of note to look at. Nothing written on a paper towel, tongue depressor, alcohol wipe packet, her hand, nothing. I could see the wheels turning as she made the numbers up. I then got the glucometer and checked the numbers. Not only had she not checked blood sugars at that time, she hadn't prior to lunch, she hadn't prior to dinner the day before, nor prior to lunch the day before. The numbers on the glucometer matched the blood sugars that the nurse working the opposite shift had documented for two days, he worked nights so had the bedtime and early AM blood sugars to do. However, those were the only blood sugars recorded on the glucometer. I notified my supervisor and was told to write a report (which I did). When the supervisors talked to the nurse, she said that she couldn't get our glucometer to work and borrowed one from next unit. Funny thing? Their glucometer was really not working so they borrowed ours in the rare instances that they needed to do blood sugars (they only had one weekly blood sugar to check)! This new nurse was turned into the Board of Nursing and rec'd disciplinary action. Wouldn't it have been much easier to just take the blood sugars?

Nursebooks2020 · Nov 26, 2019

that sucks

Nunya, BSN · Nov 27, 2019

Does the glucometer have records of BS's that far back? That might help.

Snatchedwig, BSN, CNA, LPN, RN · Nov 28, 2019

Your place is a mess. Your administration wants yall to make up numbers--- your fellow nurses are not even documenting....hello??? This ain't forgetting to document if Sally got her fish oil pill...this is INSULIN.

Imma need you to find another place to work.